Healthcare Provider Details

I. General information

NPI: 1316117740
Provider Name (Legal Business Name): ORIAN MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1874 PIEDMONT AVE NE SUITE 390 C
ATLANTA GA
30324-4884
US

IV. Provider business mailing address

1874 PIEDMONT AVE NE SUITE 390 C
ATLANTA GA
30324-4884
US

V. Phone/Fax

Practice location:
  • Phone: 404-249-8641
  • Fax: 404-249-8642
Mailing address:
  • Phone: 404-249-8641
  • Fax: 404-249-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. GUILLERMO AVILES
Title or Position: PRESIDENT
Credential:
Phone: 678-234-0675